[Predictors of Blood Transfusion after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Blood...

To investigate the predictive indexes of blood transfusion after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with blood diseases.

From January 2018 to December 2022, 188 patients with blood diseases who underwent allo-HSCT in our hospital were enrolled, and divided into non-transfusion group (104 cases) and transfusion group (84 cases). Gender, age, preconditioning regimens, granulocyte and platelet implantation time, donor and recipient relationship, human leucocyte antigen (HLA) compatibility, blood type compatibility, red blood cell (RBC), hemoglobin (Hb), and platelet (PLT) before transplantation, the number of peripheral hematopoietic stem cells, mononuclear cells (MNCs), total nucleated cells (TNCs), and CD34⁺ cells, RBC, PLT, and plasma transfusions before and during transplantation, as well as the occurrence of cytomegalovirus (CMV), Epstein-Barr virus, nephritis, pulmonary infection and graft-versus-host disease (GVHD) after transplantation were collected in the two groups. Univariate and multivariate analysis of the above data affecting post-transplantation blood transfusion were performed. ROC curve was used to analyze the diagnostic efficacy of post-transplantation blood transfusion.

The RBC count in the non-transfusion group before transplantation was 2.60(2.27, 3.14)×10¹²/L, which was significantly higher than 2.43(2.11, 2.82)×10¹²/L in the transfusion group (P<0.05). During transplantation, the RBCs infusion was 3.50(1.00, 5.50) U and the PLT (therapeutic volume) infusion was 3.00(1.80, 4.95) in the non-transfusion group, which were lower than 4.25(2.00, 8.00) U and 4.00(2.60, 6.80) in the transfusion group (both P<0.05). The incidence of pulmonary infection and GVHD was 38.46% and 29.81% in the non-transfusion, respectively, which was lower than 53.57% and 45.24% in the transfusion group in the late post transplantation period (both P<0.05). CD34⁺ cell content (OR =0.851, 95%CI: 0.744-0.970, P<0.05) was an independent protective factor for post-transplantation blood transfusion, while GVHD (OR =1.986, 95%CI: 1.077-3.660, P<0.05) was an independent risk factor. The diagnostic efficacy of CD34⁺ cells alone (AUC=0.578, 95%CI: 0.497-0.660, P>0.05) or GVHD alone (AUC=0.577, 95%CI: 0.495-0.660, P>0.05) for blood transfusion was poor, while their combination (AUC=0.629, 95%CI: 0.550-0.710, P<0.05) significantly improved the diagnostic efficacy compared to a single indicator.

Graft CD34⁺ cell content is an independent protective factor for blood transfusion after allo-HSCT in patients with blood diseases, while GVHD is an independent risk factor. It is of clinical significance to combine the two indexes to predict the blood transfusion strategy after transplantation.